A Red State Embraces Part Of Health Care Overhaul

I'm Jacki Lyden and this is TELL ME MORE from NPR News. Michele Martin is away this week. Coming up, spring hails all sorts of lovely flowers and in Washington it brings cherry blossoms on the trees that ring the city's tidal basin. We'll share the story behind the famed cherry blossoms in a few minutes. But first, the Supreme Court opens a three-day hearing today about the Obama administration's Affordable Care Act.

The court's decision, expected by July, could uphold the law or strike it down completely or get rid of some provisions. From the beginning, several states have opposed the law as an overreach of federal authority. Mississippi and Florida are just two of them. In a moment, we'll hear from Florida's Senate president about that state's concerns about the law.

First though, we're going to talk about Mississippi, where surprisingly a health exchange called for in the Affordable Care Act could survive even if the federal law is defeated. An exchange is a system where consumers can compare costs and benefits of different insurance plans. Jeffrey Hess is a BYLINE who's covered this issue and he joins us now.

Jeffrey, welcome to the program.

JEFFREY HESS, BYLINE: Thank you, Jacki.

LYDEN: So before we talk about the insurance exchange, tell us about how many people in Mississippi would be affected?

HESS: Oh, 275,000 by the exchange alone. If you include the Medicaid expansion, you could be talking about another 150,000. Adults in Mississippi, there's almost a half a million uninsured adults. If you include children, there's about 600,000 uninsured people in the state. The expectation from experts here is that the insurance exchange and the Medicaid expansion could drop the uninsured rate from 20 percent to six or seven percent.

LYDEN: So you've got this unusual situation in Mississippi, at least when it comes to the exchange portion of the law, kind of swimming against other Southern states. Let's listen to insurance commissioner Mike Chaney. You did an interview with him. Let's listen to part of it.

(SOUNDBITE OF INTERVIEW)

MIKE CHANEY: It's important that we have an exchange that's designed by Mississippians, operated by Mississippians, for Mississippians. We don't want an exchange from the federal government that one size fits all. What may work in New York State may not work in the state of Mississippi.

LYDEN: So Jeffrey Hess, why does Commissioner Chaney believe this is so important?

HESS: Well, this is an idea that's been kicking around the state for years. I'm stretching back to the mid-2000s. I found speeches by former Governor Haley Barbour extolling the virtues of the exchange and their competitive market ability to bring down insurance rates as well as provide people an easier access point to purchase insurance, which is really complicated to buy. The state legislature has tried and failed three or four times, including in 2008, when a bill passed in the Senate.

The main hang-up not being whether or not to establish the exchange, just whether or not to have it be a private non-profit board or have the state run it. So it's something that state legislators and politicians in Mississippi have been considering for years.

LYDEN: And how will this exchange work?

HESS: Well, that's still to be determined. It is going to be a private non-profit thanks to a 2009 rule change to the state's high risk pool. The high risk pool is going to run the exchange, administer the exchange. They've got a board. It's met, I believe, twice now. The expectation is it's going to run a little more like Utah's, which is just an open market and any company can come in, instead of like Massachusetts, where the state picks out each plan that will be available on the marketplace.

That's partly due to the fact that Mississippi just does not have a lot of insurance companies that want to compete in our market. So that the more open, the better.

LYDEN: Now, Jeffrey given that you've got a Republican governor, Republican majority in the State Senate. The House just flipped for the first time since Civil War to the Republicans in Mississippi. How is Mike Chaney, your insurance commissioner, selling support for this element, at least, of the Obama administration's Affordable Care Act?

HESS: He has been, and I've seen him make this speech at least a half a dozen times to various business groups and to various political groups, a very vocal supporter of the exchange idea as a mechanism for bringing down insurance rates. He pitches it as this is a market solution where you can have a larger pool of people vying for a larger group of insurance market plans. So he's putting out there saying this isn't the government running it, and if we wait on this, it will be the federal government running this, so we need - like you heard in his soundbite, where we need Mississippians to run it.

So, he's pitching this as a market solution for Mississippians.

LYDEN: And what's Mississippi prepared to do if the act is struck down by the Supreme Court, and what is it going to do if it's upheld?

HESS: Well, the state has already taking about 20 or 22 million dollars to go ahead and set this exchange up. So as far as that's concerned, the train is on the tracks. It's something that the state has wanted. Now you've got the federal government paying for it for free. It's going to be self-sustaining once it's set up, so it's not going to cost the state anything. So why stop at that point?

You might as well just go on ahead and keep making it. The big concern, if the Supreme Court strikes down the whole law, is that the exchange is a mechanism not only for getting insurance companies and customers together but for getting federal subsidies to come to the state, and that would be in the neighborhood of $900 million dollars that would come to the state to help people pay for the premiums of insurance, which is the main reason people don't have insurance because the premiums are really expensive.

So without that premium support, even if you have an exchange, there's a question of how well it could work because you still haven't addressed the main concern for most Mississippians, which is insurance is just really expensive.

LYDEN: Jeffrey Hess is a reporter with Mississippi Public Broadcasting and he joined us from Jackson, Mississippi. Thank you very much for being with us.